Office of the Secretary



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NEW YORK STATE

DEPARTMENT OF PUBLIC SERVICE


Office of the Secretary


Three Empire State Plaza

Albany, N.Y. 12223

The cable television company Annual Financial Report (AFR-1) is required to be file with this Department, in DMM Matter Number 09-01904, no later than 90 days after the close of the company fiscal year.
Late filing of the Annual Financial Report can subject the company to the forfeiture provisions of Article 11, Section 227-a of the Public Service Law. Section 227-a provides, in part, that

any cable television company which (a) shall fail to make and file its annual report as and when required or within such extended time as the Department may allow, or (b) shall fail to make specific answers to any question within the period specified by the Commission for the making and filing of such answers, or (c) shall fail to submit such special reports as the Commission may, from time to time require, within the period specified by the Commission for the submission thereof, shall forfeit to the state the sum of one hundred dollars for each and every day such company shall continue to be in default with respect to such annual report, answer or special report”.


If you require an extension of time in which to file your report such request must be in writing and received at least 10 business days before your report is due. A form for requesting an extension of the time in which to file is provided with this notice.
The following instructions are provided to eliminate the most common errors made on prior AFR’s.
When completing the Statement of Profit and Loss:


  1. Report all revenues at the gross amount earned.




  1. Report on line 3 all revenues earned from regulated activities including basic and cable programming service tiers, and equipment rentals and sales.




  1. Report on line 4 all revenues earned from non-regulated programming service tiers, including remaining tiers, A la carte, pay per channels and pay per view services.


When completing the Schedule of Expenses (page 14), report on line 30, column B of the schedule, the programmer supplier costs for pay services in addition to the costs of other fees and royalties paid for broadcast and similar rights. Also, include on line 23, column (c) payments to municipalities or community access organizations for funding PEG access.
Submitting an incorrect AFR will require the submission of an amended AFR.

NOTE: EMAIL COMPLETED FORM TO: secretary@dps.ny.gov


TO BE FILED IN DMM MATTER NUMBER: 09-01904


FORM AFR – 1


Annual Financial Report for Period Beginning ,

and Ending ,



Name:

Full Name of Cable Television Company
Address:

Mailing Address

City: State: Zip Code:




Telephone #: FAX #:

(Include Area Code) (Include Area Code)


Business Entity:
Indicate if a Sole Proprietorship; Partnership; Limited Partnership; Corporation;

Not for Profit; other (describe).


-1-

Notice


This report shall be filed with the Department by every company providing cable television services, which is required to maintain records in accordance with the Uniform Reporting System, and may be filed by any company providing cable television services, which voluntarily maintains its financial records in accordance with the Uniform Reporting System.



This report shall be filed with the Department within 90 days of the end of your fiscal year.

Part I of this report consists of questions of a general informational nature. Part II consists of financial statements and schedules based on the account descriptions employed on prior year AFR forms. Part III consists of consolidated financial statements that must be completed when one of the following situations exists.




  1. Reporting company has an equity interest of 20% or more in another company, or




  1. Reporting company operates in whole or in part in a state other than New York or has significant non-cable activities. In such cases, the New York State cable activities will be reported in Part II and all other activities plus New York State activities will be reported in Part III.

Additional instructions for completing Part III are on page 16.



General Instructions





  1. All entries are to be in permanent form. Negative amounts are to be enclosed in parentheses.




  1. The words “not applicable” are to be shown on any schedules or in reply to any question, which does not apply to respondent.

3. Additional explanations, schedules or statements may be attached to the back of this form for the purpose of further explanation. The additional explanations, schedules or statements shall be cross-referenced to the question, statement or

schedules to which they are related.
4. Amounts reported on the AFR shall be rounded to the nearest dollar.


  1. If you require assistance phone (518) 474-6530 or write New York State Department of Public Service, Office of the Secretary, Three Empire State Plaza, Albany, N.Y. 12223.

ANNUAL FINANCIAL REPORT (AFR)


REQUEST FOR FILING EXTENSION



Instructions


  1. The request must be made by the proprietor, general partner or an officer and received in our office at least 10 business days before your report is due.



  1. Give the reason why an extension is needed. Please note that an initial extension, if granted, will normally not exceed 30 days. An additional extension or an extension for longer than 30 days, may be granted upon demonstration of unusual circumstances.




  1. Please mail completed form to the Secretary to the Commission, New York State Department of Public Service, Three Empire State Plaza, Albany, N.Y. 12223. If you have any questions concerning extensions, please call (518) 474-6530 or FAX (518) 486-6081.




Name of Company

Mailing Address

City State Zip Code



(Area Code) Phone (Area Code) FAX

REASON FOR REQUEST

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Financial Report for Period Ending Length of Extension Requested
Signature of Requester Title
Printed Name of Requester Date Signed

-2-


PART I



1. To whom should correspondence and inquiries concerning this report be addressed?



Name Mailing Address



Title City





Area Code and Phone # State Zip Code

2. List below the name of each municipality granting a franchise and each

Geographic area you serve in which a franchise has not been granted.

In addition, provide information for each municipality and area served

as indicated on table below. Indicate operation in a non-franchised area

by placing the letter “N” after the area served.

All fractional numbers should be rounded to the nearest tenth.
An illustration is provided for the correct method for filling out the demographic

information. The Village of Anywhere has 100 subscribers, 50% penetration,



10.0 miles of plant completed and 10.5 total route miles in franchise area.
Should you serve more localities than space provided, please make additional copies of page 2b.






A.




B.




C.




D.




E.




Franchise Area




Number of




Estimated %




Total Miles




Total Route




Served




Subscribers




of Penetration




of Plant




Miles in






















Completed




Franchise Area




SAMPLE

























a.

Anywhere, V.




100




50.0




10.0




10.5

1

 




 




 




 




 

2

 




 




 




 




 

3

 




 




 




 




 

4

 




 




 




 




 




(Sub) Total




 




 




 




 

______________



  1. Identify whether a locality is a city, town, village or unincorporated area by using the following codes:

‘C’ – City, ‘T’ - Town, ‘V’ – Village

  1. Total amount of first or primary outlets not to include additional outlets or other services.

  2. % of penetration – number in Column B divided by number of homes passed.

D. Total plant miles completed

E. Total miles of plant required to be constructed in municipality.


-2b-





A.




B.




C.




D.




E.




Franchise Area




Number of




Estimated %




Total Miles




Total Route




Served




Subscribers




of Penetration




of Plant




Miles in






















Completed




Franchise Area






























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(Sub) Total




 




 




 




 

-3-

3. At any time during the reporting period did the reporting company own or control 20 % or more of another company?

YES NO

If yes, list the name(s) of the companies held.


Name of Company Owned Percent of Included In Part III

Ownership

Yes/No

4. Did another company own or control 20% or more of the reporting company during the reporting period?

If yes, list the companies having ownership.
Name of Company Percent of

Ownership

-4-


CABLE AFR-1 CERTIFICATION

I certify that I have examined this report and that all

statements of fact contained therein are true, complete, and

correct to the best of my knowledge, information, and belief

and that nothing material has occurred that would require

explanation that has not been explained.



Signature Title

Printed Name of Signer Date Signed

Name of Company


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